AHLT235 Chapter 8 Key Terms

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Across
  1. 1. For a $200 allowed charge for an office visit, a patient has a $15 copay, and the PPO pays 80% of the participating provider’s usual charge, the remaining _____ will be billed to the patient.
  2. 3. An amount of time that must pass before a newly hired employee is eligible to enroll is called ____ period
  3. 6. Largest employer-sponsored program in the US _______ Employees Health Benefits Program
  4. 7. A patient pays for a cosmetic procedure that is not medically necessary under the terms of the plan. This payment does not count toward the __________.
  5. 9. Utilization Review Organization is hired by a payer to evaluate medical ______.
  6. 10. HMOs do not have a _______.
  7. 14. Options purchased by employees to add voluntary benefits such as vision and dental.
  8. 15. Gives an employee who is leaving a job the right to continue health coverage under the employer’s plan for a limited time at his/her own expense.
  9. 16. With a PPO plan, a patient may see an out-of-network _______
  10. 17. Has a narrow choice of providers, who are primary care physicians for the patient
  11. 18. An ____ is an account designed to pay for qualified medical expenses of individuals who have PPO.
Down
  1. 2. If a policy has a 20-day waiting period, on the _____ day the health coverage become effective.
  2. 4. Plans that require premium, deductible, and coinsurance payments.
  3. 5. Individual _____ must be met for each person that is covered
  4. 8. Most plans require employees to pay ____ premium.
  5. 11. Plan Employees may choose from a wide array of medical benefit options
  6. 12. During specified periods, called open ______, the employee chooses a particular set of benefits for the coming benefit period.
  7. 13. A monetary amount after which benefits end is called _____ benefit limit
  8. 16. Is a hybrid of HMO and PPO networks.
  9. 17. Consumer-driven health plans combine a high deductible health plan and a ____.